Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida 33021, USA.
Ann Thorac Surg. 2010 Mar;89(3):885-90. doi: 10.1016/j.athoracsur.2009.11.034.
Esophageal endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS) are gaining popularity for mediastinal staging of patients with lung cancer. Endoscopic ultrasound and then EBUS were introduced into a single-surgeon thoracic surgical practice. Records were reviewed to determine what effect this had on performance of mediastinoscopy for lung cancer staging, and on discovery of unsuspected N2 disease at the time of resection.
Endoscopic ultrasound and EBUS were introduced 10 months apart. Records were reviewed for the 10 months before EUS (phase 1), the 10 months between EUS and EBUS (phase 2), 8 months after the introduction of EBUS (phase 3), and 11 months after that (phase 4). The number of staging procedures, patients undergoing resection after negative staging, and patients with N2 disease discovered at resection were determined.
Two hundred fifty-three patients met inclusion criteria. Eighty-two had resection without staging; staging was positive in 62, negative in 90 who went on to resection, and negative in 19 who had no further evaluation. There was a strong trend toward preferential use of EUS in phase 2 and EBUS in phases 3 and 4. Nine patients (10%) had N2 disease found at surgery: 0 of 16 in phase 1, 4 of 24 in phase 2, 3 of 24 in phase 3, and 2 of 25 in phase 4. Overall sensitivity and negative predictive value of EUS and EBUS were 84% and 87%, respectively.
Introduction of EUS and EBUS reduced use of mediastinoscopy. Discovery of N2 disease at surgery was higher than expected initially, but with experience results proved comparable to those of mediastinoscopy.
食管内镜超声（EUS）和支气管内超声（EBUS）在肺癌纵隔分期中的应用越来越受欢迎。内镜超声和 EBUS 随后被引入一位胸外科医生的单一手术实践中。我们回顾了记录，以确定这对肺癌分期的纵隔镜检查的表现以及在切除时发现未被怀疑的 N2 疾病有何影响。
EUS 和 EBUS 相隔 10 个月引入。回顾记录了 EUS 前的 10 个月（第 1 阶段）、EUS 和 EBUS 之间的 10 个月（第 2 阶段）、EBUS 引入后的 8 个月（第 3 阶段）和之后的 11 个月（第 4 阶段）。确定分期程序的数量、接受阴性分期后行切除术的患者以及在切除时发现 N2 疾病的患者。
共有 253 名患者符合纳入标准。82 例患者未行分期而行切除术；62 例分期阳性，90 例阴性患者继续行切除术，19 例无进一步评估的患者分期阴性。第 2 阶段更倾向于优先使用 EUS，第 3 和第 4 阶段更倾向于使用 EBUS。9 例（10%）患者在手术中发现 N2 疾病：第 1 阶段 16 例中 0 例，第 2 阶段 24 例中 4 例，第 3 阶段 24 例中 3 例，第 4 阶段 25 例中 2 例。EUS 和 EBUS 的总体敏感性和阴性预测值分别为 84%和 87%。
EUS 和 EBUS 的引入减少了纵隔镜检查的使用。手术中发现 N2 疾病的比例最初高于预期，但随着经验的积累，结果与纵隔镜检查相当。
